Open Access Open Badges Research article

Disparities in attendance at diabetes self-management education programs after diagnosis in Ontario, Canada: a cohort study

Karen Cauch-Dudek1, J Charles Victor12, Marianne Sigmond3 and Baiju R Shah145*

Author Affiliations

1 Institute for Clinical Evaluative Sciences, G106 – 2075 Bayview Avenue, Toronto, ON, M4N 3M5, Canada

2 Dalla Lana School of Public Health, University of Toronto, Toronto, Canada

3 Division of Endocrinology, University Health Network, Toronto, Canada

4 Department of Medicine, University of Toronto, Toronto, Canada

5 Department of Medicine, Sunnybrook Health Sciences Centre, Toronto, Canada

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BMC Public Health 2013, 13:85  doi:10.1186/1471-2458-13-85

Published: 30 January 2013



Patients newly-diagnosed with diabetes require self-management education to help them understand and manage the disease. The goals of the study were to determine the frequency of diabetes self-management education program utilization by newly-diagnosed patients, and to evaluate whether there were any demographic or clinical disparities in utilization.


Using population-level health care data, all 46,553 adults who were diagnosed with any type of non-gestational diabetes in Ontario, Canada between January and June 2006 were identified. They were linked with a diabetes self-management education program registry to identify those who attended within 6 months of diagnosis. The demographic and clinical characteristics of attendees and non-attendees were compared.


A total of 9,568 (20.6%) patients attended a diabetes self-management education program within 6 months of diagnosis. Younger age, increasing socioeconomic status, and the absence of mental health conditions or other medical comorbidity were associated with attendance. Patients living in rural areas, where access to physicians may be limited, were markedly more likely to attend. Recent immigrants were 40% less likely to attend self-management education programs than longer-term immigrants or nonimmigrants.


Only one in five newly-diagnosed diabetes patients attended a diabetes self-management education program. Demographic and clinical disparities in utilization persisted despite a publicly-funded health care system where patients could access these services without direct charges. Primary care providers and education programs must ensure that more newly-diagnosed diabetes patients receive self-management education, particularly those who are older, poorer, sicker, or recent immigrants.

Diabetes self-management education programs; Utilization of health services; Disparities; Population-based research